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Reducing the need for repeat surgeries

Engineers have developed imaging technology that could help breast cancer surgeons confirm whether they have cut out the entire tumour.

About 300,000 new cases of invasive breast cancer are discovered annually. Of these, 60 to 75 percent of patients underwent breast-conserving surgery.

Breast-conserving surgeries, or lumpectomies, attempt to remove the entire tumour while retaining as much of the undamaged breast tissue as possible (in contrast, a mastectomy removes the entire breast). The extracted tissue is then sent to a lab where it is rendered into thin slices, stained with a dye to highlight key features, and then analysed. If tumour cells are found on the surface of the tissue sample, it indicates that the surgeon has cut through, not around, the tumour – meaning that a portion of the tumour remains inside the patient, who will then need a follow-up surgery to have more tissue removed.

After a week or two waiting for lab results, 20 to 60 percent of patients find out that they must return for a second surgery to have more tissue removed. Says Lihong Wang, the Engineer leading the project, "What if we could get rid of the waiting? With 3D photoacoustic microscopy, we could analyse the tumour right in the operating room, and know immediately whether more tissue needs to be removed." Wang’s lab saw the invention of 3D photoacoustic microscopy.

Photoacoustic microscopy, or PAM, excites a tissue sample with a low-energy laser, which causes the tissue to vibrate. The system measures the ultrasonic waves emitted by the vibrating tissue. Because nuclei vibrate more notably than surrounding material, PAM reveals the size of nuclei and the packing density of cells. Cancerous tissue tends to have larger nuclei and more densely packed cells.

As described by Wang and his team, PAM produces images capable of highlighting cancerous features, with no slicing or staining required.

Although Wang's team has focused primarily on breast cancer tumours, his work has potential applications for any analysis of excised tumours – from melanoma to pancreatic cancer. In a proof-of-concept scan described in the new paper, PAM analysed a sample in about three hours. Comparable traditional microscopy takes about seven hours to achieve the same results. However, Wang says that PAM’s analysis time could be cut down to 10 minutes or less with the addition of faster laser pulse repetition and parallel imaging. This would make the technology useful for clinical applications.

"Because the device never directly touches a patient, there will be fewer regulatory hurdles to overcome before gaining FDA approval for use by surgeons," Wang says. "Potentially, we could make this tool available to surgeons within several years."

Research carried out by engineers at the Optical Imaging Laboratory, led by Lihong Wang, Bren Professor of Medical Engineering and Electrical Engineering.